v3.25.1
CONDENSED CONSOLIDATED STATEMENTS OF CASH FLOWS (UNAUDITED) - USD ($)
$ in Thousands
3 Months Ended
Mar. 31, 2025
Mar. 31, 2024
Cash flows from operating activities    
Net income $ 6,221 $ 16,862
Adjustments to reconcile net income to net cash provided by operating activities:    
Depreciation and amortization 6,849 5,096
Amortization of debt issuance cost 691 458
Share-based compensation 7,811 5,748
Non-cash lease expense 1,287 3,155
Change in fair value of contingent consideration liabilities 1,407 0
Loss on debt extinguishment 375 0
Unrealized loss (gain) on investments 44 (1,099)
Loss (income) from equity method investments 867 (632)
Deferred tax (358) (7,248)
Other (557) 6,795
Changes in operating assets and liabilities, net of business combinations:    
Receivables, net (10,368) (26,128)
Receivables, net - related parties (6,589) (3,374)
Other receivables 3,688 (1,403)
Prepaid expenses and other current assets 2,674 (4,255)
Other assets (314) 92
Accounts payable and accrued expenses 8 905
Fiduciary accounts payable (3,383) 56
Medical liabilities 3,319 (808)
Income taxes receivable 3,514 14,542
Operating lease liabilities (1,090) (3,083)
Other long-term liabilities 531 298
Net cash provided by operating activities 16,627 5,977
Cash flows from investing activities    
Payments for business acquisition, net of cash acquired 0 (50,649)
Proceeds from repayment of promissory notes, including those with related parties 600 6
Purchase of marketable securities (24) (27)
Issuance of loan receivable 0 (20,000)
Purchases of property and equipment (3,070) (369)
Distribution from investment - equity method 100 0
Net cash used in investing activities (2,394) (71,039)
Cash flows from financing activities    
Dividends paid (5,455) (95)
Borrowings on long-term debt 412,000 110,000
Repayment of long-term debt (428,232) (3,500)
Payment of finance lease obligations (147) (179)
Deferred financing cost (17,241) 0
Proceeds from ESPP purchases 301 0
Taxes paid from net share settlement of restricted stock (4,052) 0
Repurchase of subsidiary's shares (1,316) 0
Proceeds from sale of non-controlling interest 0 150
Purchase of non-controlling interest (28) (25)
Net cash (used in) provided by financing activities (44,170) 106,351
Net (decrease) increase in cash, cash equivalents, and restricted cash (29,937) 41,289
Cash, cash equivalents, and restricted cash, beginning of period 289,101 294,152
Cash, cash equivalents, and restricted cash, end of period 259,164 335,441
Supplemental disclosures of cash flow information    
Cash paid for income taxes 4,338 194
Cash paid for interest 7,360 6,430
Supplemental disclosures of non-cash investing and financing activities    
Business acquisition in accounts payable and accrued liabilities 0 63,935
Right-of-use assets obtained in exchange for operating lease liabilities 5,729 4,910
Common stock issued in business combination 0 21,952
Purchase of investments - equity method in accounts payable and accrued liabilities and other liabilities 0 9,487
Draw on letter of credit through Revolver Loan 0 4,759
Dividend paid in the form of common stock 21,935 0
Reconciliation of cash, cash equivalents, and restricted cash    
Cash and cash equivalents 258,517 334,796
Restricted cash 647 645
Total cash, cash equivalents, and restricted cash shown in the statement of cash flows $ 259,164 $ 335,441

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